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2015, Number 2

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Rev Hematol Mex 2015; 16 (2)

Optimizing the monitoring of patients with plasma cell dyscrasias

Gertz MA

Language: English
References: 17
Page: 105-108
PDF size: 289.47 Kb.


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INTRODUCTION
In the United States, multiple myeloma is the 14th most common cancer with an estimated 24,050 patients diagnosed in 2014. Myeloma represents 1.4% of all new cancer in the United States with a median age at diagnosis of 69 and a median age at death of 75. The five-year survival for the years 2004 through 2010 is 44.9%. With the introduction of novel agents, deep responses ≥nCR are now approaching 60%. The assessment of patients with multiple myeloma has utilized measurement of either the M-spike or the quantitative heavy chain by nephelometry. These techniques, based on 1960s technology, have major drawbacks. The half-life of IgG is 25.8 days. As a consequence, confirmation of a ›90% reduction in M protein (VGPR) can take 10 weeks, even when marked cytoreduction of the myeloma population has occurred. This delay is not consistent with an individualized management strategy for myeloma patients. The normal level for IgG in human serum is 15,000 mg/L and for IgM 500 mg/L. The visual detection of a monoclonal peak on a serum protein electrophoresis can occur with levels as low as 2,000 mg/L. However, particularly for IgA monoclonal proteins that migrate in the beta region, transferrin, C3, and beta lipoprotein interfere with the estimates of the Mspike. At low levels, immunoglobulin levels cannot distinguish polyclonal from the myeloma immunoglobulin.


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